- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $446.68 / $1,096.48
| Facility | | $77.62 | $446.68 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $234.42 / $602.56
| Professional | | $91.20 | $234.42 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $302.00 / $812.83
| Facility | | $234.42 | $302.00 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $257.04 / $977.24
| Professional | | $107.15 | $257.04 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $630.96 / $912.01
| Facility | | $501.19 | $630.96 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $436.52 / $1,000.00
| Facility | | $199.53 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $691.83
| Professional | | $154.88 | $309.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $645.65 / $8,511.38
| Facility | | $58.88 | $645.65 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $436.52
| Professional | | $371.54 | $371.54 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $426.58
| Professional | | $257.04 | $257.04 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $302.00 / $812.83
| Facility | | $234.42 | $302.00 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $257.04 / $977.24
| Professional | | $107.15 | $257.04 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $416.87
| Facility | | $154.88 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $257.04 / $489.78
| Professional | | $102.33 | $257.04 | $489.78 |